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Overview

While vaccines remain the best strategy to prevent COVID-19, recent evidence suggests monoclonal antibodies (nMABs) or antivirals could potentially benefit certain vulnerable populations before or after exposure to SARS-CoV-2, such as the unvaccinated or recently vaccinated high-risk patients.

With the recent roll out of nMABs and antivirals, there is an urgent need to for knowledge and understanding around the use of nMABs and antivirals in the treatment of patients with COVID-19, such as factors of relevance in determining nMAB and antiviral treatment and the impact of nMAB and antiviral treatment in the community and hospital settings.

This OpenSAFELY report..

The code and data for this report can be found at the OpenSafely antibody-and-antiviral-deployment repository.

Introduction

Methods

Results

Coverage of COVID-19 treatment

Between 11-Dec-2021 and 10-Feb-2022, a total of 47,700 non-hospitalised patients registered at a TPP practice in England were identified as being eligible for receiving a nMABs or antiviral for treating COVID-19 (Figure 1). Within the same time period, a total of 5,980 patients had received a nMABs or antiviral treatment for COVID-19 (Figure 2);

  • Paxlovid: 20;
  • Sotrovimab: 3,290;
  • Remdesivir: 0;
  • Molnupiravir: 2,610;
  • Casirivimab: 50,

For all subsequent analysis by high risk cohort, patients identified as being eligible for receiving a nMABs or antiviral for treating COVID-19 have been included within each high risk cohorts that their records indicate they fall into. Out of the 47,700 eligible patients, 45,030 (94%) were included in two or more high risk cohorts (range 1 - 6).

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Figure 1: Cumulative total of patients eligible for receiving a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohort. Note, eligible patients can appear in more than one high risk group and the overall number (pre 10th February 2022) in each group is likely to be an overestimation due to including patients where their SARS-CoV-2 infection is confirmed by a lateral flow or polymerase chain reaction test.

Figure 1: Cumulative total of patients eligible for receiving a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohort. Note, eligible patients can appear in more than one high risk group and the overall number (pre 10th February 2022) in each group is likely to be an overestimation due to including patients where their SARS-CoV-2 infection is confirmed by a lateral flow or polymerase chain reaction test.

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Figure 2: Cumulative total of patients who received a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohorts. Note, treated patients can appear in more than one high risk group

Figure 2: Cumulative total of patients who received a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohorts. Note, treated patients can appear in more than one high risk group

Delivery of nMAB and antiviral treatment

Figure 3: Weekly proportion of eligible patients receiving a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohort and treatment type

Figure 3: Weekly proportion of eligible patients receiving a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohort and treatment type

Table 1: Proportion of eligble patients who have recieved treatment for COVID-19 since 11th December 2021, broken down by high risk cohort and treatment type
Treated
Eligible
All
Paxlovid
Sotrovimab
Remdesivir
Molnupiravir
Casirivimab
High risk cohort Count Count % Count (%) Count (%) Count (%) Count (%) Count (%)
All 47700 5980 13 20 (0) 3290 (55) <5 2610 (44) 50 (1)
Immune-mediated inflammatory disorders 19200 2800 15 10 (0) 1550 (55) <5 1220 (44) 20 (1)
Primary immune deficiencies 9390 1120 12 10 (1) 580 (52) <5 530 (47) 10 (1)
Solid cancer 7810 900 12 <5 510 (57) <5 370 (41) 10 (1)
Rare neurological conditions 5340 860 16 <5 440 (51) <5 410 (48) 10 (1)
Haematological diseases and stem cell transplant recipients 3550 820 23 <5 450 (55) <5 360 (44) 10 (1)
Solid organ transplant recipients 3300 800 24 <5 500 (62) <5 290 (36) 10 (1)
Renal disease 2960 760 26 <5 500 (66) <5 260 (34) 10 (1)
Liver disease 2950 290 10 <5 150 (52) <5 140 (48) <5
Down’s syndrome 1020 140 14 <5 50 (36) <5 90 (64) <5
Sickle cell disease 730 50 7 <5 20 (40) <5 30 (60) <5
Immuosupression due to HIV or AIDS (CD4 <350 cells/mm3) 320 190 59 <5 70 (37) <5 120 (63) <5

Key demographic and clinical characteristics of treated patients

Table 2 shows the number and proportion of patients who had received treatment by 10-Feb-2022, broken down by demographic and clinical categories and treatment type.

Table 2: Count and proportion of eligible patients who have received treatment for COVID-19, broken down by demographic and clinical categories and by and treatment type
Treated
Eligible
All
Paxlovid
Sotrovimab
Remdesivir
Molnupiravir
Casirivimab
Group Variable Count Count % Count (%) Count (%) Count (%) Count (%) Count (%)
Age band 30-39 6140 920 15 <5 530 (58) <5 380 (41) 10 (1)
Age band 40-49 7960 1240 16 0 (0) 710 (57) <5 520 (42) 10 (1)
Age band 50-59 9480 1340 14 10 (1) 760 (57) <5 570 (43) 10 (1)
Age band 60-69 8140 1030 13 <5 570 (55) <5 440 (43) 10 (1)
Age band 70-79 6800 690 10 <5 360 (52) <5 320 (46) <5
Age band 80+ 4330 240 6 <5 100 (42) <5 140 (58) <5
Sex Female 26880 3490 13 10 (0) 1960 (56) <5 1500 (43) 20 (1)
Sex Male 20820 2490 12 10 (0) 1340 (54) <5 1120 (45) 30 (1)
Ethnicity White 38020 5050 13 20 (0) 2810 (56) <5 2180 (43) 40 (1)
Ethnicity Asian or Asian British 2440 320 13 <5 200 (62) <5 120 (38) <5
Ethnicity Black or Black British 1960 180 9 <5 90 (50) <5 80 (44) <5
Ethnicity Mixed 640 80 12 <5 40 (50) <5 40 (50) <5
Ethnicity Other ethnic groups 780 90 12 <5 40 (44) <5 50 (56) <5
Ethnicity Unknown 3860 270 7 <5 120 (44) <5 150 (56) <5
IMD 1 most deprived 9800 860 9 <5 480 (56) <5 360 (42) 10 (1)
IMD 2 9460 1110 12 <5 610 (55) <5 490 (44) 10 (1)
IMD 3 9660 1330 14 <5 720 (54) <5 590 (44) 10 (1)
IMD 4 9070 1230 14 <5 690 (56) <5 530 (43) 10 (1)
IMD 5 least deprived 8380 1270 15 10 (1) 690 (54) <5 570 (45) 10 (1)
IMD Unknown 1330 180 14 <5 100 (56) <5 80 (44) <5
Rurality Urban - conurbation 13000 1280 10 <5 710 (55) <5 570 (45) <5
Rurality Urban - city and town 24440 3200 13 10 (0) 1680 (52) <5 1480 (46) 30 (1)
Rurality Rural - town and fringe 5510 790 14 <5 490 (62) <5 300 (38) 10 (1)
Rurality Rural - village and dispersed 3470 530 15 <5 330 (62) <5 190 (36) 0 (0)
Rurality Unknown 1280 170 13 <5 100 (59) <5 80 (47) <5
Region East Midlands 8560 970 11 10 (1) 680 (70) <5 270 (28) 20 (2)
Region East of England 11240 1890 17 <5 1000 (53) <5 860 (46) 20 (1)
Region London 3050 400 13 <5 160 (40) <5 240 (60) <5
Region North East 2620 310 12 <5 230 (74) <5 80 (26) <5
Region North West 5100 560 11 10 (2) 270 (48) <5 290 (52) <5
Region South East 2930 380 13 <5 210 (55) <5 170 (45) <5
Region South West 5340 860 16 10 (1) 400 (47) <5 450 (52) <5
Region West Midlands 1970 230 12 <5 180 (78) <5 50 (22) <5
Region Yorkshire and the Humber 6820 370 5 <5 170 (46) <5 200 (54) <5
Region Unknown 60 10 17 <5 0 (0) <5 <5 <5
Autism Autism 270 40 15 <5 10 (25) <5 20 (50) <5
Care home Care home 1560 60 4 <5 10 (17) <5 50 (83) <5
Dementia Dementia 1150 40 3 <5 10 (25) <5 30 (75) <5
Learning disability Learning disability 1220 150 12 <5 60 (40) <5 100 (67) <5
Serious mental illness Serious mental illness 640 70 11 <5 30 (43) <5 30 (43) <5
Housebound Housebound 1710 170 10 <5 80 (47) <5 80 (47) <5
CEV CEV 25190 4230 17 10 (0) 2370 (56) <5 1810 (43) 40 (1)
Vaccination status Un-vaccinated (declined) 760 30 4 <5 20 (67) <5 10 (33) <5
Vaccination status Un-vaccinated 2230 110 5 <5 50 (45) <5 60 (55) <5
Vaccination status One vaccination 1520 120 8 <5 60 (50) <5 50 (42) <5
Vaccination status Two vaccinations 7200 510 7 <5 270 (53) <5 230 (45) 10 (2)
Vaccination status Three or more vaccinations 36000 5210 14 10 (0) 2890 (55) <5 2270 (44) 40 (1)

Concordance with guidance

Of the 5980 patients who received treatment for COVID-19 between 11-Dec-2021 and 10-Feb-2022, 1,165 patients were missing records needed to confirm eligibility. It is likely that most, if not all, of these patients meet all of the eligibility criteria and non of the exclusion criteria but, for example, their SARS-CoV-2 test result is not available in their record or we just do not have access to all the criteria the clinician might use to assess high risk group status (such as the patients identified via non digital methods).

Figure 3: Breakdown of eligibility criteria variables in treated patients with missing records needed to confirm eligibility

Figure 3: Breakdown of eligibility criteria variables in treated patients with missing records needed to confirm eligibility

Time to treatment

Figure 4a: Time between positive SARS-CoV-2 test and treatment for COVID-19, broken down by treatment type

Figure 4a: Time between positive SARS-CoV-2 test and treatment for COVID-19, broken down by treatment type

Figure 4b: Time between positive SARS-CoV-2 test and treatment for COVID-19, broken down by high risk cohort

Figure 4b: Time between positive SARS-CoV-2 test and treatment for COVID-19, broken down by high risk cohort